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In this episode of the Before the Hospital Podcast, host Hamish McLean interviews Joe Acker, CEO of the EMS Global Foundation, who brings 35 years of experience in running emergency medical services across Australia and Canada. Joe discusses the critical need for EMS leadership to balance high professional standards with a "leading with love" approach. He explores the challenges of shifting EMS culture from traditional paramilitary structures toward a modern healthcare-focused model, emphasizing the importance of transparency, showing up for staff, and building strong collaborative partnerships rather than operating in isolation.

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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When I sat down in Brisbane to record this Before the Hospital conversation with Dr Khikmat Anvarov in Uzbekistan, I expected a discussion about ambulances and equipment. What I heard instead was a thirty‑year story of how Uzbekistan has tried to rebuild emergency care as a national system rather than a collection of services.

For colleagues working on EMS in resource‑constrained systems, this episode offers a rare, first‑hand account from one of the architects of reform – and a reminder that emergency care is built through governance, pathways and people long before the hospital door.

We talk about:
•Why buying more ambulances and equipment is not enough in post‑Soviet and LMIC settings.
•How inter‑district emergency hospitals were designed to serve around one million people each.
•What telemedicine and “expertise travelling faster than the patient” now look like in practice.
•The political and practical realities of long‑term EMS reform in Uzbekistan, and why honest reporting of delays and gaps matters more than perfect metrics.

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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Dr Biyamba graduated from medical school in Mongolia and went straight to the ambulance. No transition, no supervised ramp-up - just the dispatch system in Ulaanbaatar and whatever came next.

In a single summer shift, he treats 30 to 40 patients. In winter, that volume climbs to 90. Of those, roughly half genuinely require an emergency ambulance. The rest receive assessment, advice, and whatever treatment can be provided at the door. Nine to fifteen patients are transported; the others stay home.

This is not a gap in the system. This is the system.

In this episode of Before the Hospital, Dr Biyamba describes what it actually takes to run emergency care in Mongolia's capital - the caseload, the equipment, the training he received, and the structural reforms needed for workforce development.

His account raises a critical health policy question that applies well beyond Ulaanbaatar: when a health system cannot afford to ease new doctors in gradually, what does that do to clinical confidence, patient safety, and amenable mortality?

In this episode:

• What a 24-hour ambulance shift looks like in Ulaanbaatar across seasons.
• How the 103 system triages who gets transported and who stays home.
• What equipment a Mongolian ambulance doctor carries—and what is missing.
• Why new doctors in Mongolia start on the ambulance rather than a supervised hospital ward.
• The specific training Dr Biyamba found most valuable, and the operational gaps that remain.

The question this episode leaves open: If the ambulance is where new doctors learn under pressure, what does that mean for the patients who are part of that learning - and is there a more sustainable model for low-to-middle-income countries?

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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The call has started. The patient is waiting. And the clinician is alone with their thoughts ... until now.

Every ambulance call begins the same way. A dispatch notification. A vehicle moving. A clinician alone, working through what might confront them and what they will do when they arrive. That window - from dispatch to arrival - is what Joe Acker calls dead time. It is largely unexamined in the research literature, inconsistently used in practice, and quietly one of the most consequential periods in prehospital care.

Simon Grosjean is an EMS physician in Aosta Valley, northern Italy. He encountered that silence on a night call - a routine case that became a breech presentation, no specialist reachable, searching the internet on his phone when his EMT partner raced him to the scene. The delivery went well. Simon was honest about why: physiology, not preparation: “This time I was lucky.”

He spent the following year building something so he would not have to rely on luck again.

EMSy is the AI-powered clinical decision support tool Simon developed not a diagnostic engine nor to replace clinical judgement. What it does is act as what Simon calls “a good librarian”: drawing together dispatch information, medication histories, ECG findings, and prehospital literature into a structured summary a provider can scan while their hands are already working. Voice-prompted. One app. No switching between tabs.

In this episode, Joe and Simon work through what dead time actually is, why dispatch framing creates tunnel vision before the clinician even arrives, and why paramedics so often leave calls without ever knowing what their patient’s diagnosis turned out to be. They then road-test EMSy against a chest pain scenario - not for the clinical content, but for what it reveals about how much cognitive preparation is possible in that pre-arrival window, and how little of it currently happens by design.

The episode closes on a question that matters for every service, everywhere. EMSy is about to be piloted in Mongolia - a place with different languages, different systems, and the same fundamental problem: a clinician, alone, moving, deciding.

This is not a conversation about technology replacing people. It is about what fills the silence before you arrive.

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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When Dr Suvd Nugui returned to Mongolia after training in the United States, she came back to a system where most of her colleagues had never heard the word “paramedic.” Neither had her parents.

Her solution was simple and radical: if she could not be everywhere, she could train people who could. Seven years later, she is training more than 80 clinicians and drivers annually with a team of international paramedics. One result: Mongolian EMS doctors are performing ECG interpretation on monitors that sat unused for months because no one knew how to operate them.

In this episode, Dr Suvd speaks with podcast host Hamish McLean about what sustained prehospital capacity-building actually looks like from the inside - the cultural barriers, the equipment gaps, the communication challenges and why a team that keeps coming back changes everything.

About Dr Suvd Nugui Dr Suvd Nugui is a Mongolian cardiologist and in-country director of the EMS Global Foundation’s Mongolia programme, where she has led training delivery and local stakeholder engagement since 2018.

Before the Hospital is produced by EMS Global Foundation. We examine how resource-constrained emergency care systems are built, funded, and reformed before the patient reaches hospital. Learn more at ems-global.org.

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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Paramedic James Stubley comes from one of the most advanced prehospital aeromedical platforms in the UK. Double-crewed, doctor-qualified, critical care at altitude. He is now teaching Mongolian on-road ambulance doctors and coming back for a second year to finish the job he started.

This episode is a short, direct answer to this question: can you deliver emergency care with basic equipment, or does complexity save lives? James has now worked in both environments. His answer matters.

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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Dolly McPherson is an aeromedical paramedic with the Hampshire and Isle of Wight Air Ambulance (UK). Her normal shift involves a helicopter, a doctor, advanced airway and trauma equipment and closed-loop communication rehearsed to the point of instinct. When something goes wrong, she has everything she needs within arm’s reach.

In Mongolia, she has her hands and whatever the team can improvise.

In this conversation, Dolly reflects on what it means to teach emergency care fundamentals to doctors whose clinical knowledge is exceptional but whose prehospital environment offers almost nothing to work with - no heated blankets in minus 40 degrees, no oxygen saturation monitors when batteries die in the cold, no protocols for safely leaving a patient at home when 75% of calls end exactly that way.

But the more searching questions run the other direction. What does it mean that a flight paramedic from the UK is teaching doctors emergency medicine and learning something back? What does Mongolian ingenuity look like when the equipment fails and the patient still needs help? And what does a system built on doing the basics exceptionally well have to teach well-resourced EMS?

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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Canadian paramedic Joe Acker watched a Mongolian ambulance doctor suture a head laceration on the roadside in the capital Ulaanbaatar, write a prescription and send the patient home. In Canada, the UK or Australia, that patient goes to hospital. No question.

That moment has stayed with him - not because Mongolia got it wrong, but because they got something right that well-resourced Western systems are just starting to replicate.

Joe Acker has spent 35 years at the senior executive level of EMS in Canada and Australia - Chief Executive of Ambulance Tasmania, Provincial Director of Clinical Practice for BC Emergency Health Services, Executive Director of EMS for Alberta Health Services. He is also a working critical care paramedic, registered in both countries. He knows what a high-income ambulance system looks like from every angle.

He keeps coming back to Mongolia anyway. On his own time.

In this conversation, Joe reflects on two years of training Ambulance 103 doctors and drivers in Ulaanbaatar - what has changed, what the training has produced, and where Mongolia goes from here. But the more searching questions run the other direction: what should the systems he came from be learning from a city doing 40 calls per ambulance per 24-hour shift with a fraction of the resources?

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/